非单纯性眼眶骨折的手术治疗

Surgical treatment of composite orbital fractures

目的回顾性分析总结手术治疗非单纯性眼眶骨折的临床经验。方法2010年1月至2017年12月,中国医科大学附属第一医院整形外科收治的587例眼眶骨折患者,男性455例,女性132例,年龄19~65岁。术前根据临床表现和3D-CT检查结果进行诊断和评估;术中充分松解还纳嵌顿的软组织、复位眼眶、放置置入体;术后比较眼眶外形、眼球功能及3D-CT等评价手术效果。结果本组587例,术后均获10个月至2年随访,所有患者术后外形和功能均得到整体的改善或恢复。12例术前眼球内陷明显,术后仍有轻度内陷;9例仍有轻度眼球运动受限、复视部分恢复;除眼球破裂摘除患者,其余患者视力较受伤前均无明显下降。结论眼眶骨折需严格依据临床表现和3D-CT检查结果进行诊断和评估,及早地进行精确复位、固定、修补,可提高治疗的效果。

Objective To summarize retrospectively the postoperative therapeutic effect of composite orbital fracture.Methods 587 patients with orbital fracture were assessed and diagnosed according to their clinical symptoms and 3D-CT reports before surgeries where incarcerated soft tissue is released and replaced thoroughly,with orbit reset as well as implants used to fix it,and then we evaluated the surgical outcomes by comparing the postoperative outlines of patients’orbits,the functions of eyeballs along with their 3D-CT evidences.Results After 10-month to 2-year postoperative follow-up,12 cases of 587 who had apparent enophthalmos preoperatively still have slightly postoperative symptoms.Although the diplopia of 9 cases is partially recovered,their eye movement remain slightly restricted.In addition,the eye function of other patients didn’t dramatically decline in comparison with that of pre-trauma,except for those undergoing enucleation of eyeballs due to ophthalmorrhexis.Conclusions Orbital fracture should be diagnosed and evaluated rigorously based on patients’symptoms and 3D-CT reports,improving treatment effects by accurate reset,fixation and repair at early stage.